Two recent cyclical changes are having a profound effect on
laboratorians.

The first development is the apparent bottoming-out of average
length of patient stay at the nation's hospitals. This
decade's decline in length of stay ended in 1986, according to preliminary data from the Department of Health and Human Services.

The second development is related to the first: Demand for
clinical laboratory services is exceeding the supply of laboratory
personnel. For a comprehensive examination of the critical staff
shortage and possible solutions, I refer you to our cover story (page
28) by Bettina Martin. This column will focus on the length of stay
trends.

A study conducted by HHS's National Center for Health
Services Research and Health Care Technology Assessment found that the
average hospital stay dropped from 7.35 days to 5.71 days, or 22.3 per
cent, between 1980 and 1985 (see Figure 1). Medicare's switch to
nationwide prospective payment provided the initial downward push. But
Dean E. Farley, Ph.D., the agency health economist who directed the
study, said: "The surprising finding was that privately insured
patients also had a sharp decline in their hospital stays."

It was not too surprising, however, in light of what the study saw
contributing to a shorter length of stay: changes in reimbursement methods; technological advances; growing reliance on outpatient
treatment; greater Government and private third-party payer scrutiny of
the need to hospitalize patients; the spread of health maintenance
organizations, which have incentives to reduce hospital use; and price
competition among hospitals.

"There was a lot of fat in this industry," Dr. Farley
said. "We ma have reached the point where we're getting down
to the bone and muscle."

Michael Bromberg, executive director of the Federation of American
Health Systems, a group of private hospitals and health care
organizations, said quality had not declined during the reduction in
hospital stays. He added: "The trend is over. Patients in
hospitals are more intensely ill than before, and the length of stay is
starting to go up again."

The American Hospital Association also had preliminary data that
indicated the length of stay decline began to reverse slightly in 1986
and 1987. "Anytime you get as sharp a change as we had, in as
short a time, one would expect it to bottom out," Alexander
Williams, a senior vice president of the association, commented.

Other findings in the HHS report merit mention. The average
hospital occupany rate dropped from 69.7 per cent in 1980 to 56.6 per
cent in 1985, and the mean number of beds per hospital fell from 216 to
204 over the same period.

The data paint a picture of retrenchment that challenged
laboratorians, compelling many to pick up additional responsibilities
and workload as staffs grew smaller, while driving others into new
careers. Now we seem to be entering a cycle of expansion, and the key
questions are: How quickly and how well can laboratory management adjust
to the change?

COPYRIGHT 1988 Nelson Publishing
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